Han1, JL. Du1*, HW. Huang2, ZF. Zhong1 and JP. Wang1

Author information

1Department of Colorectal Surgery, Affiliated Jinhua Central Hospital, Zhejiang University School of Medicine, Jinhua, China;
2Department of Medical Imaging, Affiliated Jinhua Central Hospital, Zhejiang University School of Medicine, Jinhua, China

Abstract

BACKGROUND: This study preliminarily explored the feasibility of local lymphatic system imaging and the assessment of metastatic lymph nodes using magnetic resonance lymphography (MRL) with rectal submucosal contrast injection in rectal cancer.
METHODS: Eighteen patients with rectal cancer were selected and received bowel preparations. They were admitted to the Department of Colorectal Surgery, Affiliated Jinhua Central Hospital, Zhejiang University School of Medicine from September 2017 to June 2018. Contrast agents (gadopentetate dimeglumine injection) were injected under the mucosa around the tumor under colonoscopy. Magnetic Resonance (MR) imaging was used, and laparoscopic radical resection of rectal cancer was performed. The sensitivity and specificity of MRL for diagnosing lymphatic metastasis of rectal cancer were analyzed and evaluated based on the results of identification of lymph nodes in the imaging examination and the pathological examination. The patients had no adverse reaction after receiving the MRL, and MRL clearly showed the lymphatic system.
RESULTS: Twenty minutes after the injection of the contrast agent, the lymph nodes began to present relatively high signal intensity, which was maintained during observation. Those lymph nodes affected by metastatic tumor presented uneven high signal intensity or no high signal intensity. After surgery, the lymph nodes affected by tumor were compared and analyzed from the perspectives of imaging and pathology. The results were herein provided: Kappa=0.870; sensitivity=83.3%; specificity=100%; Positive Predictive Value (PPV)=100%; Negative Predictive Value (NPV)=92.3%; this indicated that MRL can improve diagnostic sensitivity, and the MRL results are consistent with the pathological examination results to a large extent.
CONCLUSIONS: MRL can visualize the anatomic forms and functions of lymphatic vessels and lymph nodes in the lymphatic drainage area in rectal cancer in a satisfactory way. It is safe and feasible for diagnosing lymphatic metastasis of rectal cancer. However, further large-scale and in-depth clinical studies are still necessary for demonstration.

Keywords:

Magnetic Resonance Lymphography, rectal cancer, clinical research

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